Don’t Be Confused by Big Salt

High blood pressure is not the only harmful effect of too much salt—it’s also been tied to stomach cancer, kidney stones, bone loss, obesity, and direct damage to our kidneys, arteries, and heart. But, as I reviewed previously in my video, The Evidence That Salt Raises Blood Pressure, there is a consensus that dietary sodium plays a significant role in raising people’s blood pressure, a dispute that has now finally been resolved.

In Sodium Skeptics Try to Shake Up the Salt Debate, I discuss the unequivocal evidence that increased sodium intake is associated with increased blood pressure, which we know leads to increased risk of vascular diseases like strokes, aneurisms, and atherosclerosis. To quote the long-time editor-in-chief of the American Journal of Cardiology, “We all must decrease our salt intake!,” a sentiment echoed by many other authorities. So, how is the food industry going to keep the salt controversy alive? If salt leads to high blood pressure and high blood pressure leads to disease, doesn’t it follow that salt should lead to disease? I mean, if A leads to B, and B leads to C, then A should lead to C, right? The logic seems sound. Blood pressure is one of the best validated surrogate markers for cardiovascular disease, and, when countries have tried cutting down on salt, it seems to have worked.

Campaigns in England were able to successfully bring down salt consumption. Blood pressures dropped, as did rates of heart disease and stroke. They also successfully brought down cholesterol levels and smoking prevalence, though, and improved fruit and vegetable consumption. In Japan, however, they dropped salt intake while eating a worse diet and smoking more, yet still saw a large reduction in stroke mortality. Based on what they were able to achieve in Finland, one daily teaspoon of salt may mean between 25 to 50 percent more deaths from heart attacks and strokes.

Are there randomized controlled trials to show that? Researchers never randomized people into two groups—one low-sodium and one not—and followed them for 20 years to see if the differences in blood pressure translated into the expected consequences. But, for that matter, such a study has never been done on smoking either. Imagine randomizing a group of smokers to quit smoking or stay smoking for ten years to see who gets lung cancer. First, it’s hard to get people to quit, just like it’s hard to keep people on a low-salt diet. Second, would it be ethical to force people to smoke for a decade knowing from the totality of evidence that it’s likely to hurt them? That’s like the Tuskegee experiment. We can’t let the perfect be the enemy of the good.

We may never get a decade-long randomized trial, but, in 2007, we got something close. There have been randomized trials of sodium reduction, but they didn’t last long enough to provide enough data on clinical outcomes. For example, the famous TOHP trials randomized thousands into at least 18 months of salt reduction. What if you followed up with them 10 to 15 years after the study was over, figuring maybe some in the low-salt group stuck with it? Indeed, they found that when people cut sodium intake by 25 to 35 percent, they may end up with 25 percent lower risk of heart attacks, strokes, and other cardiovascular events.

This was considered the final nail in the coffin for salt, addressing the one remaining objection to universal salt reduction. It was the first study to show not only a reduction in blood pressure, but a reduction in hard end points—morbidity and mortality—by reducing dietary sodium intake. Case closed, 2007.

But, when billions of dollars are at stake, the case is never closed. One can just follow the press releases of the Salt Institute. For example, what about the Institute of Medicine report saying that salt reduction may cause harm in certain patients with decompensated congestive heart failure? An analysis of those studies has since been retracted out of concern that the data may have been falsified. It is certainly possible that those with serious heart failure, already severely salt-depleted by high dose salt-wasting drugs, may not benefit from further sodium restriction. However, for the great majority of the population, the message remains unchanged.

What about the new study published in the American Journal of Hypertension that found the amount of salt we are eating is just fine, suggesting a kind of u-shaped curve where too much sodium is bad, but too little could be bad, too?

Those biased less towards Big Salt and more towards Big Heart have noted that these studies have been widely misinterpreted, stirring unnecessary controversy and confusion. It basically comes down to three issues: measurement error, confounding, and reverse causality. All these data came from studies that were not designed to assess this relationship, and they tended to use invalid sodium estimates simply because it’s hard to do the multiple, 24-hour urine collections necessary to get a good measurement. And, in the United States, many of those eating less salt are simply eating less food—maybe because they’re so sick—so it’s no wonder they’d have higher mortality rates. So, compiling these studies together is viewed as kind of like garbage in, garbage out. But why would they do that? They claim to have no conflicts of interest. When confronted with evidence showing at least one of the co-authors received thousands of dollars from the Salt Institute, they replied they didn’t get more than $5,000 from them in the last 12 months, so, no conflict of interest!

If you instead look only at the trials in which they did the gold-standard, 24-hour urine collections in healthy people to avoid the reverse causation and controlled for confounders, the curve instead has a continuous decrease of cardiovascular disease (CVD) events like heart attacks and strokes as sodium levels get lower and lower. There was a 17 percent increase in risk of CVD for every gram of sodium a day. And, this is for people without high blood pressure. We’d expect the benefit to be even greater for the 78 million Americans with hypertension. Unfortunately, the media has widely misreported the findings and a false sense of controversy has been broadcast, confusing the public. But it’s not just the media. When editorials are published on the subject in some of the most prestigious medical journals in the world, you don’t expect them to be written by someone who got paid personal fees by Big Salt. Before she accepted money from the Salt Institute, the author was accepting money from the Tobacco Institute and was a frequent expert witness in defense of Philip Morris and other tobacco companies. So, if that’s who the New England Journal of Medicine chooses to editorialize about salt, you can see the extent of industry influence. The editor-in-chief of the American Journal of Hypertension himself worked for many years as a consultant to the Salt Institute.

This video is part of my extended, in-depth series on sodium, which includes:

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

186 responses to “Don’t Be Confused by Big Salt”

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Healthy salt intake is one area that I remain confused on. I’ve always thought that the salt naturally found in unprocessed food would be adequate but there are others such as Dr. John McDougall who has suggested that a diet with unprocessed food with no added salt may actually be unhealthy. I think most would agree that diets with too much added salt is unhealthy but the question in my mind would be is a diet of unprocessed plant food with zero added salt healthy or could this result in some negative health issues?

Thanks for the link, I enjoyed reading it. So, it seems better to mimic Jack Lalanne than to be a vegan and a couch potato. (No pun intended). You could also try to be vegan body-builder, but I don’t think the plant protein is going to have the same results as moderate amounts of lean meat and fish. Especially if you are trying to gain weight like me. I also don’t like the idea of getting my protein from a powder mix of sugar from a can. Thanks.

I think the answer is to take lots of regular exercise and eat lots of fruit and vegetables. A whole food plant based diet can include small amounts of meat and fish.

However, I’d definitely skip the meat since the World Health Organization reviewed all the scientific evidence and concluded that it probably increases cancer risk.

Of course, using your reasoning, you are probably much better off skipping the Jack LaLanne approach altogether. He only made it to 95. George Burns lived to 100. He smoked cigars. That must have been his secret – smoking cigars.

Just because one person makes to a particular old age doesn’t necessarily mean that evrything that person did and ate was healthy. Sometimes people make it to old age despite smoking like a chimney, drinking like a fish and eating crap.

To my mind, asking what happens to most people is more meaningful In the 7th Day Adventist mortality study, they looked at the risk of death according to diet among over 96,000 people. Meat eaters (non-vegetarians) had the highest mortality risk of all while among men “vegans” had the very lowest mortality with “pescatarians” (fish eaters) having the second lowest mortlity risk (table 4)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191896/

The drug companies are directing the research (as they always do) and attempting to bury the more recent information about the sodium/potassium balance.
Doctors are still telling everyone in sight to reduce salt. When they should be saying increase potassium!
But that would negatively impact blood pressure medicine sales!

However if you look at the facts, the health and nutrition authorities keep telling us to eat more fruits, vegetables and whole grains (ie increase our potassium intake) and reduce our sodium intake.

‘Adults should consume less than 2,000 mg of sodium, or 5 grams of salt, and at least 3,510 mg of potassium per day, according to new guidelines issued by the WHO. A person with either elevated sodium levels and low potassium levels could be at risk of raised blood pressure which increases the risk of heart disease and stroke.

Sodium is found naturally in a variety of foods, including milk and cream (approximately 50 mg of sodium per 100 g) and eggs (approximately 80 mg/100 g). It is also found, in much higher amounts, in processed foods, such as bread (approximately 250 mg/100 g), processed meats like bacon (approximately 1,500 mg/100 g), snack foods such as pretzels, cheese puffs and popcorn (approximately 1,500 mg/100 g), as well as in condiments such as soy sauce (approximately 7,000 mg/100 g), and bouillon or stock cubes (approximately 20,000 mg/100 g).

Dr. Pam Popper recently did a two-hour teleconference on the book The Salt Fix, which argues that the increase in heart-rate from low sodium intake is worse than the small uptick in BP, except in cases of specific sensitivity, which is rare.

The Salt Fix is by pharmacist Dr James DiNicholantonio, a leading saturated fat and cholesterol sceptic.

As for Dr Pam Popper, she is a well known health guru but nobody seems to know from where she got her doctorates (she apparently has doctorates in naturopathy and nutrition)

I wouldn’t personally regard either of them as credible experts on salt, nor would I consider their opinions as constituting a serious debate on the matter.

Dr Greger’s assessment appears spot on. I’d consult scientific reports by the World Health Organization and the US National Academies of Science in preference to sensational popular books or YouTube videos

Are they compensating? For example, people that follow a ketoacidic diet need to pee more to save the kidneys from failure (too acidic). But doing so lowers the concentration of electrolytes in he blood. Thus, they come to think that large amounts of salt is healthy.

Another example. People that do sauna everyday would need more salt to stay alive or feel better (specially things related with nerves or weakness).

I have Ehlers Danlos Syndrome, and salt is the only seasoning I’m allowed to have with all of my medical issues. What is the right amount of salt for a person like me? We tend to need salt, and we don’t absorb nutrients the same way as others, so we are lacking nutrients most often than others. We feel better with salt, and when we don’t have it, we lose energy, and our fatigue is debilitating. Thanks…

Yes!, you’re right, Ehlers Danlos Syndrome (EDS) would be among those few cases where salt (or sodium) intake shouldn’t be restricted or limited. This is due to the postural orthostatic tachycardia syndrome (POTS), a dysfunction of the autonomic nervous system.

According to the articles that I’ve been reading (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4294907/), The four basic principles of POTS management are (1) patient education; (2) nonpharmacologic volume expansion with salt and water replacement; (3) pharmacologic therapy (mineralocorticoids, cholinergics, β-blockers); and (4) physical conditioning/physical counter maneuvers

The nonpharmacologic interventions include generous water intake (about 2 – 2.5 lt per day), include salty snacks, no caffeine or alcohol, and raising the head of the bed.

I didn’t find any mention of how much salt a patient should include per day.

However, I found other info on EDS forums where other people give advice about their experiences, although it might not be medical advice or any evidence-based, so if you might want to talk to your doctor about the recommendations you find in here >>

I’m really curious if salt is so dangerous, why do we crave it so much? I’m not talking about as learning it as a preference but even babies with virgin taste buds will prefer the saltier version of a home made puree, which makes no sense to me if it would be detrimental.

We crave what we eat. I have been a vegan for many years and have a family history of heart disease and hypertension. I do not add salt and do not crave it. I do not crave meat, milk, eggs, and candy bars. When there was no candy available, did prehistoric people crave candy bars, salt shakers, and huge amounts of meat? No. Studies of the plaque on the teeth of prehistoric people showed that they ate mostly plants with very small amounts of meat. The modern food industry has developed food deliberately to increase cravings, especially of salt, saturated fat, and processed sugar. These are not natural cravings evolved by people through the millennia of our existence.

As I’m always trotting out (ad nauseum) in Dr. G’s endless salt videos — in fact, just a few weeks ago, in his most recent one — a fasting blood test taken in June of this year showed my sodium level at 133 when it’s supposed to be within 135-145. Potassium was fine, at 4.8 (“normal” is between 3.5-.5.5), but my chloride was at 94, when it’s supposed to be between 95-108. I certainly don’t want to have another hyponatremia incident (summer of 2010) when I landed in the ER.

Speaking of Big Salt, might it be possible that Big Blood Test and BS are “in bed with each other”? As it were? :-)

I would have died as a child as a prehistoric person then, because I have to have protein from a meat source to survive. I was vegan for 3 years, and worked with dedicated doctors, herbalists, and holistic practitioners, and when my health declined so rapidly in 3 years, they all concluded that I needed meat based protein, salt, lots of veggies, and low fat meals. I eat chicken, fish, and eggs, and without them, I would be in trouble. Salt is a huge part of my diet, and when I came off of it, it almost landed me in the hospital.

Oh, I just love it when some idiot with keyboard courage thinks they know more than every doctor I’ve been to in my entire life! Oh, and your paranoia of the possibility that I’m lying needs to be dealt with in a therapist office. I dealt with bullying all my life, because of my sister being handicapped, and if you think for one minute that you are going to get under my skin, buddy, you got another thing coming! I spit idiots like you out for breakfast! Lol!!! If you weren’t so lazy, you could have done the smallest amount of research about my condition, and had the answer to your own question. I was born with a genetic condition idiot! It affects every aspect of my body! That includes blood cells that break, because they aren’t strong enough to carry iron, and oxygen through my system. My body doesn’t make enough either, and my body doesn’t absorb nutrients well either. I eat a ton of salt, and every time I’m tested my levels are too low. I don’t get enough nutrients from beans, lentils, soy, and supplements. Yes, like I have stated many times in this article, if my body was built like everyone else that might work for me, but I’m not like you, so stop thinking you can bully people with your narrow views, attacks, and idiocy. It’s hilarious how you actually think that just because it’s working for the majority it must work for everyone. You really can’t think beyond what you’re told in media can you? They aren’t going to talk about people like me, because that doesn’t push their agenda, and not that their agenda is wrong, but it isn’t for everyone. You obviously are an extremist, and you have your own agenda! I tried for 3 solid years to make it work until it almost killed me. I tried every vegan protein and high iron choices that existed during that 3 years, and with high end supplements, and absolutely no amount that I shoved in my mouth worked! Oh, and as far as the money goes, on top of my disorder, a young girl ran a stop sign, killing her mother, and critically injuring me, so I have less than $100 to my name, and I’m in the process of having to get disability. I fault hard to not have to get on it, and took very little pain meds, and now I have no choice. I can’t work, and the doctors are the ones pushing me for disability. I’m out of money now, and gave in, not that you’d care. Most people like you are just angry and lonely, because they are so selfish people can’t stand them. Go back to your keyboard, and do some honest research with real people suffering with EDS, and then get your degree in medicine, and then maybe you will be worth responding to again! Lol! Hilarious!!! Despite my struggles, at least I know I’m loved, because I give love. Maybe one day you will figure that out for yourself, and stop attacking people when they are already struggling with things past your own understanding. Peace out!! Lol!

For one thing, no “added salt” per the standard WFPB definition, does not mean sodium-free either. Besides we have the evidence that salt in miso does not seem to be a problem, so that decriminalizes miso as a condiment…

I find myself cooking mostly without salt, but I will use miso and occasionally some Bragg’s Liquid Aminos. Also not salt-free, but low in salt.

But I would like to see a specific critical review of The Salt Fix. And ad hominem attack on the author will not do, as he sites very specific and extensive research.

If you are referring to my comments, referring to the author as a leading saturated fat and cholesterol is a simple statement of fact. One, incidentally, that I think he would consider an accolade. My other comment that neither he nor Popper have any speciaal expertise in the area of salt and health, was also a statement of fact. If you want to paint those as ad hominem attacks, then your understandig and my understanding of what that term means are clearly very different.

‘Science’s defenders have identified five hallmark moves of pseudoscientists. They argue that the scientific consensus emerges from a conspiracy to suppress dissenting views. They produce fake experts, who have views contrary to established knowledge but do not actually have a credible scientific track record. They cherry-pick the data and papers that challenge the dominant view as a means of discrediting an entire field. They deploy false analogies and other logical fallacies. And they set impossible expectations of research: when scientists produce one level of certainty, the pseudoscientists insist they achieve another.’https://www.newyorker.com/news/news-desk/the-mistrust-of-science

Hi TG: To me it seemed that raising the matter about Pam’s degrees without any substantiation was at least a cheap shot, and at worst an ad hominem attack. Be that as it may, I’d like to stay focused on the facts.

There is another plant-based doctor here in NYC, Michelle McMacken from NYU Langone, who in her standard recommendation also includes some amount of iodized salt. She still maintains the general avoidance of lots of added salt, but definitely she does advise a little iodized salt at the table.

As to dealing with “The Salt Fix,” I would like some day to see a serious review of that book from a source I trust. I have generally found Pam Popper’s advice to be solid, but this issue is too big to go by a single marker…

The paper itself has been roundly criticised, by the World Health Organization among others

‘Professor Francesco Cappuccio, head of the World Health Organization’s Collaborating Centre for Nutrition, attacked both the methods used in the study and the journal for agreeing to publish it.
“It is with disbelief that we should read such bad science published in The Lancet,” he said.
Professor Cappuccio said the article contained “a re-publication of data” used in another paper.
“The flaws that were extensively noted in their previous accounts are maintained and criticisms ignored,” he said’https://www.independent.co.uk/news/science/salt-diet-heart-disease-death-lancet-a7040546.html

Your patience in answering these somewhat ridiculous questions and statements I find admirable. It is like watching you have a battle of wits with a lot of unarmed men. Thanks for the interesting and educational read.

Thank you very much. I should add that it is not only the World Health Organization that has criticised the Andrew Mente/McMaster University led study as bad science. The American heart Association has also weighed in on this study eg

‘Elliott Antman, M.D., associate dean for clinical/translational research at Harvard Medical School and senior physician in the Cardiovascular Division of Brigham and Women’s Hospital in Boston, said the findings of the new study should be disregarded.

“This is a flawed study and you shouldn’t use it to inform yourself about how you’re going to eat,” said Antman, immediate past president of the AHA. “The AHA has reviewed the totality of the evidence and we continue to maintain that no more than 1,500 milligrams of sodium a day is best for ideal heart health.”

The AHA is one of numerous health organizations and governmental bodies that encourage sodium limits for health reasons.

However, the friends of the dairy and salt industries will no doubt continue to try to undermine the worldwide scientific consensus that the great majority of people wll benefit from reducing their sodium consumption to reduce their risk of premature mortality and death. As Dr G says, ‘don’t be confused by big salt’ – or its friends for that matter.

“Your patience in answering these somewhat ridiculous questions and statements I find admirable. It is like watching you have a battle of wits with a lot of unarmed men. Thanks for the interesting and educational read.”
– – – – – –

It sounds like you know from “ridiculous.” Do I smell a snob in the house?

TG here enjoys his role as Resident Devil’s Advocate, don’t you TG? :-)

If you consider commenting that people should place more weight on well-designed scientific studies and on dietary/health guidelines and comprehensive scientific reviews underpinned by multiple lines of evidence – and less weight on the claims of people selling books, supplements and woo generally – makes me a devil’s advocate, then yes.

I just think that claims by alternative health advocates that we should be eating more saturated fat, that high cholesterol is protective and higher salt consumption is healthy, damage people’s health and increase the risk of early death. They also benefit, of course, the huge meat and dairy industries. And the entire medical industry including the dreaded Big Pharma for that matter.

Ignorance can kill. This why NutritionFacts is so helpful.

Unfortunately there’s not much that can be done about wilful stupidity. Except to challenge the opinionated claims it produces.and to prevent its statements being accepted by default.

Someone once said that the trouble with the world is that the stupid are cocksure. Can’t argue with that Their argument is usually along the lines of: my claims are true, I have no real evidence that they are true but here’s a bunch of testimonials, and unless you can prove my claims are false beyond a shadow of doubt, everybody must accept that my claims are true. When their claims are shown to be false, they then accuse the person exposing their claims as false as being an agent of the FDA, the NWO, the Illuminati or whatever, or of being a shill for Big Pharma, Monsanto, Big Ag, Big Cancer etc

You do know that this website is about nutrition facts and scientific evidence about nutrition?

My feedback is that I LOVE when you do this type of detail and illustrate a controversial subject in a way where the brushstrokes of the arguments are given so that we can wrap our minds around the debate, and yet you have also given enough detail and powerful studies that this can be a jumping off point as we research the topic on our own.

You could have just put: “In Japan, however, they dropped salt intake while eating a worse diet and smoking more, yet still saw a large reduction in stroke mortality. Based on what they were able to achieve in Finland, one daily teaspoon of salt may mean between 25 to 50 percent more deaths from heart attacks and strokes.” and I would have already had enough understanding to make life decisions from.

My favorite writing transition was:

“It was the first study to show not only a reduction in blood pressure, but a reduction in hard end points—morbidity and mortality—by reducing dietary sodium intake. Case closed, 2007.

But, when billions of dollars are at stake, the case is never closed.”

Billions of dollars are at stake….. yes, that explains everything.

I have been pondering this issue often because of Dr. McDougall telling people to go ahead and use the teaspoon of salt to increase the palatability of foods and because it is one of those hotly debated topics.

RichardW, Dr McDougall does not feel we need a lot of salt. The foods prepared for the 10 day and weekend seminars is often low/no salt. If I remember correctly, what he does say is that if sprinkling a little salt on the surface of food will get you to eat the food, then do it. (by sprinkling the surface of food just before eating means your tongue will taste it first, and you will use much less in his opinion. ) He says this several places on his website although he could have changed his opinion. Same with sugar. A little sugar on a bowl of oatmeal makes the difference for many whether they will eat it or not.

My mother is addicted to salt. Since she was our cook as kids, we tend to crave salty food too. But there is no history of heart trouble in our family. As she got older her dependence on salt grew. Now she salts all her food even before tasting it, and cannot enjoy a meal without a saltshaker in her hand or close by. She will be 99 in November, 2018. She was in an assisted living home for a few years, and all the ladies were shocked and made comments about her salt intake, but she has outlived most of them. I have come to the conclusion that, contrary to where the world seems to be going, we are all different, with different needs, and doctors should study the patient more than the books.

As I posted earlier, my recent blood test showed that although my sodium level was a disturbing 133 (135-145) and chloride level was also low, at 94 (95-108), my potassium level clocked out to be a happy 4.8 (3.5-5.5) — right smack in the middle of the “good” range.

All the doc’s office said (when I called two weeks later) was, “The blood test was normal.” I had to go down there and pick up the paper copy of the results.

Okay, so maybe I’m a bit anal in the having-to-know-blood-test-results department. It seems a lot of people couldn’t care less about their test results. And then there are those who insist on getting a paper record so they can compare it to future/past blood tests.

If I hadn’t had that hyponatremia incident, I probably wouldn’t give a rat’s ass either.

He means any salt. Personally I don’t trust the processed salts purported to be heated to 1000 degrees. and prefer to use the unprocessed salts. That being said, we still need to keep our daily sodium under 1,500 mg.

Believing that very expensive salt (eg Himalyan, sea salt etc) is less harmful cheap table salt has no scientific justification, They are both very high in sodium ….. and that is the core of the problem.

I would love to know or have confirmed is all salt created equally? I rarely eat anything processed which I have noted contain high amounts of salt. I also steer away from table salt generally. I do use as little processed as I can find Himalayan salt and sea salt which I thought also contain other trace minerals. Mainly just small amounts in preparing foods and baking occasionally. Wondering if it’s best to just leave the salt out and adjust to that.

From what I understand, as long as you keep your sodium intake under 1,500 mg/day, your good. An unprocessed WFPB diet usually contains ~500 mg of sodium. Personally I do add a little salt to my beans and soups and still keep sodium under 1,500 mg.

I can never figure out how people measure the salt using the mg method. I just go by the “shakes” from my salt shaker. How many shakes of the salt shaker (with medium-sized “eyes”) equal 1500 mg?

I seem to average around four shakes a day — whatever that adds up to be. Mainly for the cereal water before it comes to a boil. That hot (hyponatremia) summer of 2010 I had never salted the cereal water, assuming I was doing a healthy thing. For other foods I’d use lemon juice as a salt substitute.

And yes, people need widely varying amounts of salt. And 1500 mg is not nearly enough for many people.

There are a ton of problems with research on salt consumption. And sadly the good doctor hasn’t probed deeply enough either.

One of the big problems is grocery store processed food. Lots of it has way too much salt. So researchers tend to take that into account. But if you’re following Dr. Greger’s suggestions on diet then you’re in a completely different group and sodium intake level.

Much of today’s research probably doesn’t apply to us very well. But we often tend to overlook that. And that’s probably not a good thing to do.

Salt is good for you. If you follow a good plant-based diet and/or sweat a lot then you may not get enough salt. And this is all an over-simplification.

But … unlike sugar, which is somewhat addictive, there is research suggesting that our intelligent bodies tend to tell us when we need more salt. If you crave it you probably need it. And yes, overly-processed foods apparently tend to skew that mechanism. So don’t eat processed foods.

The body is also capable of shedding reasonable amounts of excess salt.

The studies on salt consumption are not valid because I think salt has a different effect on vegans than it does on people who consume animal products. I believe it has something to do with the fact that animal fat is not water soluble and vegetable oils like avocados olive oil coconut peanut butter are. When you eat commercial salt or any salt with a diet of animal fat the salt stays in your body longer as the salty animal fat slowly breaks down. But on a vegan diet and using only pink salt from the USA or Europe the salt flushes out of your body much quicker. I’ve been a vegan with honey for 47 years love good real salt and at 70 in pretty great shape. And my family has a history of heart disease.

Hi, So stop eating all salt and see what happens. I love salt but as a healthy whole foods eating vegan for 47 years I believe I found a balance. I’m not consuming nearly as much salt as those who eat highly processed foods but enough salt to keep the balance I need. My body wants some of the good salt. The only “study” that would be relevant to someone like me would be a study of healthy whole foods eating vegans who consume salt against the same who don’t consume salt, And since that will never happen I have to go by my gut as they say. As far as contaminants well here is an interesting article on some interesting studies. http://www.dailymail.co.uk/health/article-2813991/Should-add-ARSENIC-tap-water-cut-breast-cancer-deaths.html

“Epidemiological data show that inorganic arsenic exposure can cause cancer of the lung and skin. The evidence of an etiologic role of arsenic for angiosarcoma of the liver is highly suggestive; however, the association between arsenic and cancer of other sites needs further investigation. No epidemiological data are available on exposure to organic arsenic compounds and cancer. Animal carcinogenicity studies involving exposure to various inorganic and organic arsenic compounds by different routes have been negative, with the possible exception of some preliminary data regarding lung cancer and leukemia. Some studies have indicated an increased mortality from lung cancer in populations living near point emission sources of arsenic into the air.”

I highly suspect that most people who are truly WFPB are so much lower in salt and so much higher in antioxidants that it isn’t as critical, but the “just not eating animal products” version of vegan has a lot more range nowadays. Lots of processed vegan foods. When I started, I was eating Mary’s Gone Crackers and Kale chips from the store, but what I know is that they talk about Lays chips and some flavors of Doritos and Nutter Butters and Twizzlers and different types of chocolate bars as vegan. They used to say Oreos, but not anymore.

So you are a Began not a Vegan. I am Began too, just recently introduced raw local honey back into the diet and I find I crave sweet less, I was using maple syrup but it is too processed. I also don’t consume oil, only use a teaspoon once or twice a week to fry my tofu or tempeh.

How about those of us who do outdoor cardio in the summer? Even 40 minutes in 90 degree heat with 50%+ humidity leaves me dripping with sweat and down a few pounds from water loss. Presumably I’m losing a large amount of sodium and other minerals at the same time. Same could be said for sauna use, something which has shown myriad benefits. If one was to keep these activities up, while eating a diet of only whole plant foods, they’d be in a daily sodium deficit. Are we really to believe that this is healthy long-term? My daily tracked intake tends to be around 4,000-7,000mg of potassium, and if not supplementing any salt only 500-1,500mg sodium. Isn’t some sort of balance important since both are critical electrolytes for just about every bodily function…?

We do sweat out some sodium in the heat, although my guess is not much. If you are feeling fine with no signs of salt deficiency, you’re probably good. I find that I do use a tiny bit more salt when I sweat a lot, but my guess is it’s probably about 200 mg more.

The following study found that after the first day of intense heat and sweating, our bodies begin to conserve sodium. However, people working in moderately hot conditions can lose up to 6 grams of sodium in their sweat.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267797/

According to the American College of Sports Medicine (ACSM), fluid deficits over 2% of body weight or more can compromised athlete’s performance and cognitive function; so, if you track your body weight first thing in the morning and after exercising, and the difference is not over 2% of the body weight, sodium losses wouldn’t be a big deal. Potassium levels can decline during exercise, similar to sodium, though losses are not as significant.

If you’re an endurance athlete ACSM also recommends:

* Athletes need to consume a fluid volume equivalent to 5–10 ml/kg BW (~2–4 ml/lb) in the 2 to 4 hours before exercise.

*Sodium consumed in pre-exercise fluids and foods may help with fluid retention

*During exercise athletes should drink sufficient fluids to replace sweat losses such that the total body fluid deficit is limited to 2% body weight.

*Ingestion of cold beverages may help reduce core temperature and thus improve performance in the heat

*Sodium should be ingested during exercise when large sweat sodium losses occur, like during prolonged exercise exceeding 2 hours in duration.

According to the ISSN the recommended sodium ingestion during exercise should be 300 – 600 mg per hour or 1.7 – 2.9 grams of salt during a prolonged exercise bout.

Articles like this calling out those who stand to loose/gain money from swaying peoples opinion on a matter with false reports and nefarious methods is covered really well in this weeks john oliver report on “astroturfing” [ https://www.youtube.com/watch?v=Fmh4RdIwswE ] which discussing the explosion of fake grass roots movements and the businesses that have spun up to drive them on behalf of industries that need the message to be different than what the studies are showing to be the case.

The Daily Mail is probably the worst “newspaper” of general circulation in the UK. It regularly publishes slanderous hit pieces against Jeremy Corbyn and its other political enemies. In poll after poll, the Daily Mail is named as the Worst of the Worst.

It’s also been cited as the only British newspaper to actively support Fascists in Europe and in the UK during the mid 1930s, and seemingly not too much has changed, since that time.

The Lancet paper itself has been roundly criticised, by the World Health Organization among others

‘Professor Francesco Cappuccio, head of the World Health Organization’s Collaborating Centre for Nutrition, attacked both the methods used in the study and the journal for agreeing to publish it.
“It is with disbelief that we should read such bad science published in The Lancet,” he said.
Professor Cappuccio said the article contained “a re-publication of data” used in another paper.
“The flaws that were extensively noted in their previous accounts are maintained and criticisms ignored,” he said’https://www.independent.co.uk/news/science/salt-diet-heart-disease-death-lancet-a7040546.html

McMaster University is a partner of the Canadian dairy industry but it may just be a coincidence that they produce papers which appear to exonerate higher consumption of nutients like saturated fat and sodium that ar found in significant amounts in dairy foods.

As a plant-based endurance athlete who trains 1.5-3 hours per day, and when competing 5-7 hours per race, I always am curious if my sodium supplementation during training and competition might be affecting my long-term health. I do not, nor does my family history have issues with high blood pressure, so I’m curious if there are words of caution and wisdom here.

If you’re an endurance athlete, sodium replacement or supplementation during training and competition, wouldn’t have to affect your health on the short or long term, because you’re replacing you sodium losses because of the sweat production or fluid loss.

In fact, is something athletes need to do because an excessive decrease in sodium may predispose athletes to cramping and hyponatremia, it can also affect the physical and mental performance.

According to the ISSN the recommended sodium ingestion during exercise should be 300 – 600 mg per hour or 1.7 – 2.9 grams of salt during a prolonged exercise bout.

But who’s to say we’re not also being played by other billion dollar international conglomerates, like “Big Coffee” and “Big Chocolate”?

Personally can confirm Dr. Gregor’s statement about how your taste buds adjust when it comes to reducing your salt intake. Taste buds also come alive after you quit smoking — but I trust no one in this Comment section (still) smokes….

‘Another variation of the faggot is pig’s fry (testicles) wrapped in pig’s caul: the pig’s fry and boiled onions are minced (ground) together, then mixed with breadcrumbs or cold boiled potatoes, seasoned with sage, mixed herbs and pepper, all beaten together and then wrapped in small pieces of caul to form a ball.’https://en.wikipedia.org/wiki/Faggot_(food)

Your body needs a certain amount of sodium, not salt. There is plenty of natural sodium in whole plant foods. I’ll be 67 in 3 months. I’ve been off salt for over 40 years and my sodium levels always test in the healthy range.

I’ve not seen any discussion about potassium/sodium ratios. That’s pretty important! Being WFPB, one consumes high amount of the potassium containing veggies. One doc told me that higher intake of potassium makes it okay to a small sprinkle of salt , just don’t stir it into the veggies and it will be fine. I think Dr. McD mentioned this too. I think Dr. G mentioned the iodized salt is important too. I can’t quote you chapter and page number about it so don’t beat me up about it. Be well friends. Pat

Research is by its nature sometimes tightly focused. More recent research has suggested that high sodium is not the only issue.

That sodium/potassium balance is especially important too. Often more important than just high sodium.

Many of the problems with sodium are apparently due to an imbalance of these two substances. And a simple suggestion of lowering sodium intake can be problematic.

We need sodium. Some days we need a lot of it. There’s a reason why you crave salt after you sweat — because you need it.

The medical community’s research into sodium has a long history of mistakes and misguidance. And they’re quite slow to adjust to new information. Doctors still prescribe lowering salt without checking more deeply or even knowing about sodium/potassium balance.

Perhaps, but he showed two studies with whole countries, which had a seriously positive result without micromanaging sodium levels.

If they “goofed” and ended up having people passing out everywhere and ending up in the hospital or with health problems from getting rid of the salt, we would be hearing that.

If whole countries can do it and have it be good, we probably don’t have to worry all that much.

The exception might be that many people only get iodine from iodized salt.

I suspect the fact that people can live and thrive even for a long time on the Rice Diet and have their health improve so much, the rest of us probably are probably getting enough if we eat things like artichokes or sweet potatoes or beets or other vegetables.

Though people who are sweating all day long are the group, which probably need electrolytes, but I just drink a water with electrolytes. Is that not enough?

There’s “salt” and then there is “salt”. A study means little to me if it does not specify what kind of salt is used in it. Is it white and sparkly? Is it simple sodium chloride? Or does it contain all the minerals… and has color and moisture? Studies in different parts of the world will use different kinds of salt. The USA uses a lot of sodium chloride (some with added iodine), but very little real salt, unrefined, sun dried sea salt.

I just wish someone could answer the hard questions. Everyone pretends to be experts on health for years now, and yet not a single doctor, or person can give the answers for every person. If they don’t know, then say so, but to pretend like their answers are the end all be all for every person just isn’t accurate. I’m not the only person with major salt deficiency. There are literally hundreds of thousands of us. The community of people with my condition could care less about agendas of big companies and industries. We shouldn’t be counted out just because our condition is rare. So many of us die every year with no cure and no answers. This issue is serious, and our lives matter, just like everyone else. We aren’t angry at anyone, just angry at the disease. We need real research with real people of every medical condition, not just healthy people, or people with high blood pressure. We all need answers. I stress about salt, but I feel worse without it. Our bodies are just different, and we need real answers, and I pray one day we get them…

It sounds like you have a diagnosed medical condition, which requires a specialist, and I pray you are able to find a good one.

The underlying cause of your condition is what you need to interact with a specialist about.

I know that it can be frustrating.

Have you been diagnosed for the medical issue?

That really is where to start and then, when you research issues like sodium, you need to be under a nutritionist or dietician or doctor who understands the medical condition.

I know that kidney and liver diseases and other medical conditions can cause it.

My cousin with kidney failure was put on sodium bicarbonate. That is a condition which I can use as an example. When he became Stage 4 kidney failure, the rules suddenly became opposite of what would be health promoting for 99% of people. He is being told to eat canned food, not fresh. Where the science for almost everybody else would be the opposite.

You are accurate that the science for every single illness known to mankind is incomplete and no doctor can do anything other than to try the things which are statistically significant in studies.

I can use my dog as an example.

I read a dog study where if owners give their dogs raw vegetables three times per week, it decreases their cancer rate by 95%. 5% of the dogs ate the raw vegetables and still got cancer and my dog already has cancer, but it doesn’t make the study wrong if it doesn’t help my dog.

My dog can only be dealt with as a special case right now. 99.999% of the vets out there won’t be highly specialized enough to treat my dog and it isn’t their fault. I say that because there are only a handful of people who have succeeded with my dog’s type of cancer. My vet isn’t specialized enough to know what to do and it isn’t his fault that he doesn’t know what to do. The truth is searching wide and far on the internet, I only found a handful of people who succeeded at all and of those people, there are only maybe 2 people on the internet who talk from experience.

The thing is, the vets who read the study and get the dog owners to eat raw vegetables are right so often that it is the protocol they should always use, but 5% of the time they will be wrong.

Hi Deb, thank you for the caring words. It was a lot better than someone earlier accusing me of being sponsored. I was diagnosed with Ehlers Danlos Syndrome a very long time ago, and have been working with the leading doctors in the US that specialize in my condition. It’s a rare disease that is actually a network of diseases within the body. The lack of collagen affects every aspect of my body, and there are too many other issues to list without going into a full on in depth medical conversation. I understand and appreciate what you are saying. What I would like to see is doctors that will say this works for some not all, and then be willing to also do the studies needed for people with rare diseases, or at least include them in the studies. I lost my sister to a different rare disease, and they treated her like a Guinea pig for 17 years until she died, but never continued research after her death. They said it was too rare, and it wouldn’t be beneficial to the larger of society, so it wasn’t worth it. However, I’m pretty sure that those patients with her terminal illness would consider it worth it. Don’t get me started on cost, because this country spends billions of dollars yearly on just cosmetics alone. We could afford it if people were caring enough to sacrifice a little for others. I know life is hard, trust me, many of my family members are all dead from this disease. My dad is dying now, I’m having trouble, and now my daughter is too. I would have never had children if I had known in time. My children have already been told not to have children, because it’s a 50/50 chance of passing this on. It’s hard being in chronic pain and fatigue daily, and watching my father dying, knowing my fate, and now my own daughter’s fate. I of all people know life is unfair. I just wish more was being done. I’m already doing everything I can, and I will never stop looking for answers until I’m gone. I’m not saying he is wrong about salt for the majority, I just want doctors to make sure they drop the egos, and be careful with their words. It’s not safe for everyone, and until further studies are done, that should be noted and discussed, and hopefully researched. The meaningless studies have already been noted before, so we need to stop wasting funds on stupid stuff like coke on rat balls, and start researching stuff that saves lives…. thanks again for being kind…

The concept of diseases being “too rare to fund studies” is heart-breaking and I agree with you whole-heartedly about us spending billions on frivolous things and then we don’t spend it on such important things.

One of my lifelong friends spent her youth on display at a Children’s hospital, because she had a rare condition. The benefit of having one as a child is that people are more heart-tugged about it. She said that it was ridiculously hard after she could no longer get treated at the children’s hospital. She said that it was seriously disconcerting when her primary care doctor examined her and acted shocked and exclaimed, “I have never seen anything like that before, did you know that was like that?” The concept of a 50-something-year-old who wants to go back to the children’s hospital is probably pretty common.

Deb, I’m so sorry about and for your friend. I hope she is still fighting, and has at least one advocate on her side. She can ask for a hospital advocate if she lives in the states. They have to provide them if I’m not mistaken.

Rational people don’t take risks for sake of taking risks. They do it because they judge the potential rewards outweigh the potential downsides. Even bungee jumpers. And people crossing the road for that matter.

Spending $500 to talk 30 minutes on the phone with some huckster isn’t called thinking outside the box- IMO it’s called being gullible and throwing money away.

Buy an electro-acupuncture kit if you want to try something outside the box – al least you will have something tangible in your hands as a result and it might just have some slight plausibility. You could even pawn it afterwards. Same with sacrificing chickens and goats – you can eat them afterwards. With ‘medical intuitives’, all you will have at the end of the day is a metaphorical large,steaming lump of bs.

“And those who were seen dancing were thought to be insane by those who could not hear the music.”

This might sound like a “curse-like” thing to say to somebody, but I sort of hope you have an NDE at some point in your life — one that you know for sure happened, no matter what others say to you (it was merely your reaction to drugs, hallucinations, etc.).

This guy – and a host of other intutives, mediums, channelers and spiritualists – are actually genuine or they are just people who have found a lucrative business that requires no capital and no staff, just an ability to charm and convince people?

There is no credible scientific evidence that any of these things are genuine – despite centuries of investigation of such phenomena.

As for that article, no it describes a well known phenomenon. It is why relying on single or a few studies is unwise. Scientists have been known to falsify results in order to get their papers published or boost their reputation. After all, no publication – no tenure. Also, if statistical analysis uses a 5% significance test (as they commonly do), it implies that one in twenty published papers contains results that occurred by chance.

It is also why, when it comes to nutrition and health (as in other fields), it is important to ensure that all the ducks line up in a row. Are observational studies supported by experimental studies (preferably randomised controlled trials) and can these in turn be explained by known mechanisms of action? And have those studies been replicated by other researchers. If that is the case, then we can be reasonably confident that the theorie correct. Otherwise, they are hyptheses (assuming they are testable, that is) that require further testing and verification.http://www.nas.edu/evolution/TheoryOrFact.html

That is why major reports on nutrition and health are important because they critically analyse all the evidence. And people like the Cochrane Collaboration perform a valuable service in critically analysing the evidence. It is why for example I never used to get a flu or pneumonia vaccination. The Cochrane Reviews indicated that they are largey ineffective in the te great majority of healthy people.

However, that is the great thing about the scientific method. It is self-critical and proceeds on the basis of both new discoveries and the finding of errors in old conclusions. That doesn’t happen in the world of woo – alternative health and New Age beliefs (actually, ancient superstions packaged for modern consumers).are based on assertions, anecdotal reports andoften certain basic ‘principles’ that can’t be tested.

Just because modern science doesn’t have perfect knowledge is no reason to prefer the wild claims of charismatic, smooth talking gurus and authors. We should apply our critical thinking skills to those claims just as rigorously as we do to scietific findings. Supporters of such people never do though.

Yes, I had an interest in NDEs myself at one time and read many of the most ppular books on the tiopic and the studies assembled by IANDS. However, it’s hardly an ironclad case. People have also been reporting such phenomena for millennia and they seem to culturally specific Hindus and animists don’t report meeting Jesus r the Christian God for example. Russians don’t usually report meeting George Washington or ben Franklin either. Nobody ever come back with practical verifiable information and the prophecies that occasionally are given all seem to be false.

Such a subjective experience (as the one you discuss in your last para) would not prove anything. It would just be a firm personal belief.based on an entirely subjective experience and no doubt culturally conditioned. False memories and hallucinations are real.

If I had an NDE and believed that I met Yamraj, god of the dead, would that prove that the Hindu religion is true and there is an afterlife? Or could it be explained by saying that I obviously wasn’t dead – we still can’t accurately define the actual moment of death – but that I did experience an extreme physiological and neurolocal trauma which was reflected by intense subjective experiences?

Even if it were true, it is hardly relevant to nutrition and health let alone the dubious studies purporting to show that high sodium consumption is safer than low sodium consumption.

Dull, disappointing, boring stuff I know. But have you ever considered that your own beliefs might just be wishful thinking? No doubt actively encouraged by book authors and other individuals who make money by promoting these sorts of happy-clappy beliefs.

My my, TG…..you put a lot of effort into your response; I’m flattered. :-) And look what you’ve learned about yourself from this little discourse! Maybe, for one thing, that you take life more seriously than is probably necessary.

As Emmanuel (EMMANUEL’S BOOK: A Manual for Living Comfortably in the Cosmos) tells us, “Enjoy the journey; Your return trip home is guaranteed.”

I have “no solid scientific evidence” that you even exist. Just because something or somebody managed to type out a few paragraphs on this screen? Nope, that’s not enough. And one could prattle on and on like this, couldn’t one! :-)

BTW, my first wife used to read all those Seth books. Then there were the tarot cards, the psychic readings and all the rest ……… but I digress

As far as I can make out, none of these books purporting to reveal channeled information from superntural entities, have ever provided a single piece of useful new knowledge or an accurate prophecy of the future …… just page after page after page of trite banalities, cliches and cod philosophy. They have however proved very profitable for their authors.

Rs, thank you.. I know, it’s just frustrating. I just think about all of the times I listened to doctors, and did everything by the book, and turned out worse than before. I know it’s trial and error. What I’m focused on in this discussion is making sure that those who need to be on salt will hear that, and not only what’s best for everyone. I know it’s a dream to want the kind of research I’m talking about, but we already know that people with POTS, and my condition, and many others benefit from being on salt. I worry about those that are newly diagnosed with brand new doctors hearing this no salt life will give them unnecessary pain and fatigue. There must be a balance of existing knowledge of conditions, and not putting everything in black and white. There is a large gray area in the healthcare industry, and all I want is for them to watch their words. What works for most doesn’t work for all, and they should be making sure that is spoken to the masses, especially doctors….

I had thought it was just a potassium issue for me as well, but I learned from my geneticist that it was more likely a magnesium deficiency. She was right, because raising my potassium did nothing, but upping my sea salt intake helped me feel better, and stopped my leg spasms, even though my levels are still low…

Yes, all the electrolytes are important. And different people have different issues with each one.

Sodium, calcium, potassium, magnesium and a number of others. Among other things they make the fluids in our body conduct electricity so that signals can be sent. Makes your brain and muscles and all kinds of stuff work.

I know two people who are allergic to saline solution and my cousin ends up having them “not believe him” every single time he is admitted to the hospital and then he swells up like a balloon and gets covered with hives and starts having breathing problems and pushes the call bell and says, “Did you happen to give me saline solution after I argued for 20 minutes that I am allergic?”

There is a little girl who is allergic to water and can only be bathed with alcohol. How many hospital visits will she be burned with water, because nobody believes her?

When I was growing up, I was allergic to baby oil and to “non-allergenic soaps and lotions” and the thing I have learned is that people do need to be flexible enough and aware enough to put everything they are doing up on the table because almost none of the studies are 100%.

It sucks to be in the 10% who got worse when 90% of the people saw improvement.

It leaves people not knowing what to do or who to trust and it doesn’t help when doctors act dogmatically about it.

No matter what, I would rather be listening to people who at least know the studies and I do wish there was enough money in the system to study the people in the various studies who the solutions didn’t work.

I ended up looking up the “allergic to water” condition and some of them cannot even drink water. They used an example of a girl who couldn’t drink water, juice or tea. She could only tolerate drinking soda.

Oh, I know right?! I totally understand about being allergic to the listed hypoallergenic products too. There are only two companies I can use for skincare, soaps, sunblock, etc. I use VMV Hypoallergenics and my favorite is Vanicream. Otherwise, I blister and break out, and have to be very careful even around other people. I picked up baby yarn once, and broke out in the store.

That’s the only sort of moisturizing oils I’ve ever used on my skin — either 100% peanut oil, coconut oil, or EVOO. We should never waste our $$$ on those fancy-shmancy creams and concoctions they’re always trying to sell you. Plus, who really knows what’s in those things?

(Off the subject: TG, you said you used to volunteer for Hospice. I wanted to myself at one time — was all set to take the course at Rockefeller Center, but my husband talked me out of it. He thought I’d bring some sad emotions back home with me (might have been right about that). But I always thought it would be fascinating to watch the nearly-deceased be greeted by those from the other side.)

Hi TG, yes, unfortunately some of us have a normal lifespan, but to be honest, I wish my own life was shorter. When you live in severe pain, and debilitating fatigue every day it’s hard to want to suffer through it. The pain is very comparable to cancer according to doctors. I haven’t had cancer, so I don’t know. I only know that I hurt in my joints, muscles, bones, and even skin. Shower water feels like knives on my skin at times, and my skin burns, and has the feeling of being raw at times, and gets rashes from pressure touching. As far as intelligence goes, I have been tested average, and above average in some areas for a person of 41, and that is common for us. We aren’t stupid, but people treat us that way. As far as salt goes, I have POTS, so I can’t say what a person with EDS without POTS would feel like. According to my personal geneticist, who specializes in this field, all EDS sufferers have a tremendous amount of trouble absorbing nutrients, and that includes salt. Each person with EDS can show different signs, which makes it hard to diagnose, but there are 6 categories within the disease. I fall into type 3 category. I’m super flexible with thin skin, and an array of multiple diseases within my disorder. Type 3 normally lives a normal life span, but is still subject to dying early if we have organ rupture, or aortic rupture. I have already lost most of my family on my father’s side (except dad), including my cousin who was only 3 months older than me. She died of aneurism. I have already had my uterus and gall bladder removed due to rupture. I almost lost my second child, and did lose my third child in pregnancy, because of it. I wouldn’t have had children if I had known soon enough what their fate would be. I love them, and they are the only reason I’m still alive. I have to be strong for them. Most of us are single, and I’m divorced, because it’s a hard life, and you have to be strong, because it’s also very lonely. People with vascular type can die very young, and unfortunately for all people diagnosed with EDS, we are all subject to dying of complications of our disease at anytime. I normally get word at minimum of 3 deaths a week in my support group. It’s a hard life, but I don’t know people that are as strong as we are, except those going through something similar. Thanks so much for showing interest. So many people suffer, and are misdiagnosed, and they are walking around with this disease not knowing it, so we try to inform others as we go about our lives. Hopefully you will share what you read with friends, and they can help someone who needs it possibly. That’s our hope..

Thank you Katherine. You have an enormous cross to bear in life which, although it is cold comfort for you, make the rest of us realise just how fortunate we are. I used to volunteer in a hospice some years ago, and that made me understand how lucky most of us are. It is a good thing to be reminded of this on a reglar basis. So, thank you.

By the way, I assume that are you aware of the POTSUK website and the studies cited there?

I can only tell you that if you’re trying to lower your intake then it’s probably not for you. I take Epsom salt baths regularly to help absorb magnesium. I also use salt water solution to clear my nose, and to a normal person, it would probably be a lot, so I would tell people to consult their doctors, because each person is different.

after all, it is the “practice” part of medical practice that gives so many concerns. The majority of physicians do the best they can based on their education and subsequent experience. Keeping up to date on the latest of everything that comes out just can’t be done. My own physician that I have built a life long relationship with has provided appreciated advice and I have seem him Google symptoms in front of patients. We as patients and physicians are all different with lots of variables involved. The body is wonderful and we will continue to try to understand it to the best of our abilities. The word Doctor means ‘teacher.’

As the authors write: “While we expected dietary sodium intake to be positively associated with both SBP [systolic blood pressure] and DBP [diastolic blood pressure], the opposite was found.”

Although the findings appear to kick against the status quo, they are in line with other recent studies asking similar questions. Research has shown that there is a “J-shaped relationship” between cardiovascular risk and sodium. This means that low-sodium diets and very high-sodium diets both carry a higher risk of heart disease.

These long-term data from the Framingham Study provide no support for lowering sodium intakes among healthy adults to below 2.3 grams per day as recommended. This study does support the finding of a clear inverse association between potassium, magnesium, and calcium and blood pressure change over time.”
“I hope that this research will help refocus the current Dietary Guidelines for Americans on the importance of increasing intakes of foods rich in potassium, calcium, and magnesium for the purpose of maintaining a healthy blood pressure.”

Observtional studies like these are notoriously subject to confounding.

A variety of conditions and medications that could be a consequence of long term high sodium intake can cause low blood pressure and thus confound observed associations.

What do randomised trials show?

‘Studies in which participants were distributed by chance into groups with high and low salt intake were analysed to investigate the effect of reduced salt intake on blood pressure (BP) and potential side effects of sodium reduction on some hormones and lipids.

One hundred and eighty-five intervention studies of 12,210 individuals lasting four to 1100 days were included, which evaluated at least one of the effect measures.
The mean dietary sodium intake was reduced from 11.5 g per day to 3.8 g per day.

TG,
“The mean dietary sodium intake was reduced from 11.5 g per day to 3.8 g per day.”

That is high sodium intake taken down to a much lower but not low sodium intake.

So how does that refute the findings of —
“Research has shown that there is a “J-shaped relationship” between cardiovascular risk and sodium. This means that low-sodium diets and very high-sodium diets both carry a higher risk of heart disease.”

Just focusing on sodium is reductionist thinking and may not find the real problem which could well be an imbalance between potassium, sodium, magnesium, and calcium. Just limiting sodium probably will not fix the lack or excess of one or more of the other three substances.

If people meet the guidelines for sodium and potassium consumption, they will have a ratio of approximately 1:1. This would help people meet BP targets.

If your conspiracy theory was true, doctors woud not be telling people to eat more vegetables, fruits and whole grains because this would bring down blood pressure as a consequence of increased dietary potassium. Nor would doctors be telling people to get more regular exrecise because this would help bring down blodd pressure too.

These sorts of conspiracy theories are entertaining and fun but examine them logically and they fall apart.

/”If your conspiracy theory was true, doctors would not be telling people to eat more vegetables, fruits and whole grains because this would bring down blood pressure as a consequence of increased dietary potassium.”/

That doesn’t fix anything.
//

It’s very hard to get enough potassium from today’s diets. Most Americans (98%) are potassium deficient!

Seven or so years ago my blood pressure was sort of “high” — this was before “experts” lowered the ideal to be 10 over 15 (yes, I’m exaggerating). A cardiologist wanted to put me on statins. It was his idiotic opinion that they “should be in everybody’s drinking water.”

He also talked me into taking Lisinopril. I’ve NEVER done well with drugs (other than an occasional aspirin). I lasted three days before I told him “no more, no way.” I weaned myself off the miserable crap and never went back to him. Nor any doctor until most recently — mainly to get a current blood test. (My BP was fine in June.)

Anyway, have you ever checked out what patients say about the drugs they’re (stupidly) taking? At the AskAPatient website here’s what they say about that killer drug, Lisinopril:

Federal law clearly states that licensed physicians may “manufacture, prepare, propagate, compound, or process drugs solely for use in the course of their professional practice” [21 USC 360(g)]. Furthermore, the Federal Food, Drug, and Cosmetic Act (FD&C) cannot regulate the therapeutic practices themselves.

Despite this, the FDA has approached individual doctors and threatened them with legal action if they continue to prescribe or use anything other than an FDA-approved drug or a drug being investigated under FDA procedures.

It is not there in black and white as you claim. You are simply misinterpreting he facts.

Wht is is there in balck and white is theFDA’s statement that some supplement are beneficial. Not to mention the fact that doctrs do actually prescibe fish oil supplements among other things. And iron and b12 and folic acid for that matter. Then there is this

The site you linked did not show that the FDA prohibits doctors from prescribing supplements. I am not American but my understanding is that the FDA has no power whatsoever to determine what doctors can and can’t prescribe.

However, it has a responsibility to enforce laws that prohibit people – including doctors – from selling products and services based on false or unfounded claims that this or that prevents or cures eg cancer or whatever

Your criticism is tantamount to complaining that the FBI tramples on the personal liberties and business activities of serial killers and kidnappers.

Give your claims here, shouldn’t you be accusing yourself of being a shill for Big Salt?

The primary contributors to dietary sodium consumption depend on the cultural context and dietary habits of a population.

Sodium is found naturally in a variety of foods, such as milk, meat and shellfish. It is often found in high amounts in processed foods such as breads, processed meat and snack foods, as well as in condiments (e.g. soy source, fish source).

Sodium is also contained in sodium glutamate, used as a food additive in many parts of the world.

Potassium is an essential nutrient needed for maintenance of total body fluid volume, acid and electrolyte balance, and normal cell function.

Potassium is commonly found in a variety of unrefined foods, especially fruits and vegetables.

Sure, it’s the public’s fault that they’re subjected to a constant barrage of wall-to-wall hypnotic advertising and a selection of products that destroy health from industries with a trillion times more money than God.

How on Earth does any of that show that Guidelines and doctors telling us to eat less sodium and eat more potassium-containing fruits, vegetables and whole grains (and take more exercise) are in fact part of a massive conspiracy to sell more blood pressure lowering medications?

It means that they are associated with the risk of disease. Observational studies like these are often confounded.

Why were people eating low sodium in these studies? In the international studies, poor people in poor countries live on rice and a handful of what’s cheap locally. That would be a low sodium diet sure. However, the explanation for why poor people on limited, nutritionally inadequate diets (and possibly unsafe water) had higher mortality than wealthier people with more varied diets, is unlikely to be the low sodium aspect.

As for studies in wealthy societies, why do people eat low sodium diets? Is it because they are all health enthisiasts eating mostly fruits and vegetables? Or is it because they are old/sick or have poor teeth which means they eat little food. It is very common for old and sick people to have poor appetites, to lose weight and suffer malnourishment. Again, it would hardly be surprising if such peole consumed less sodium than the average and also experienced higher mortality/disease rates.

This is why simplistic obervational studies are not always relialbe guides – especially when they are contradicted by well-designed experimental studies.

It’s been brutally humid these past few weeks in the Eastern US. I’m training for a 10k and several days a week I do an hour or more of intense cardio exercise. Even when I choose a time of day when it’s not super hot, the humidity is still very high and I come home soaking wet from perspiration. I feel like I earned myself a tofu hot dog.
At wat pont is sodium replacement necessary? (I can’t stand coconut water).

Karen, If I were you, I wouldn’t wait to find out. Just keep the home fires burning with sodium foods (so long as you don’t have high BP). I live in NY state, so I know what you mean about heat and humidity. This weather can’t last too much longer.

If I had known the “at what point” my sodium level was starting to drop to dangerous levels (in my case, the ER found it had plunged down to 123 back in 2010), I surely would have paid more attention. Maybe I had felt a little tired that morning while out walking …headache-y? Dizzy? Don’t remember. I seem to be one of those who has to learn things the hard way. :-)

I had gone from asking a friend “Who IS this?” when she called me on the phone, to more or less coming around 3-4 hours later — perched on a hospital bed with the needle of a saline solution stuck in my arm. You sure don’t want to get yourself hyponatremia!

‘Q: I exercise vigorously for 1 to 2 hours a day, sweat a lot, and often notice salt residue on my skin after I have cooled down. Do I need to ingest salt tablets to replace the salt I lose in sweat?

A: No, you do not need to ingest salt tablets, although you train up to 2 hours a day. Yes, it is true that your sweat has salt in it, approximately ¼ to ½ teaspoon per quart. However, even if you sweat approximately 1 to 2 quarts per hour of exercise, the salt lost from your body is easily replaced from the diet and sports drinks (1,2). Also, if you train hard on a regular basis, you are unlikely to develop a salt deficiency even with high sweat rates on hot days because training promotes changes in your body that conserve salt.

Some athletes, however, need to be concerned about adequate salt intake. American football athletes, for example, can lose 10 quarts of sweat a day during twice-a-day practice sessions (3). Ultramarathon athletes can sweat out gallons of body water during prolonged race events. The danger for these athletes is low body sodium levels (i.e., hyponatremia) (4,5). If water or other low-sodium beverages are consumed in high amounts, the loss of sodium in the sweat causes the sodium level in the blood to fall too low, causing symptoms similar to heat illness. These symptoms include fatigue, light-headedness, weakness, cramping, weight gain, nausea, bloating and/or swelling, dizziness, headache, confusion, fainting, disorientation, and seizures or coma (severe cases).

Do you eperience any symptoms from your ‘low’ blood pressure or does your doctor express any concern about your BP levels/sodium levels? If not, increasing sodium consumption may not actually be beneficial

That doesn’t strike me as a bad thing (unless your doctor or you have any other concerns) and females in any case tend to have lower BP than males so ‘normal’ figures for both sexes may not be normal let alone ideal for females.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945367/

Hi:
I eat very few, if any processed foods. I’m a vegetarian for 30 years. What I notice
is if I don’t add some salt to my diet, I get light-headed. I also know
elderly people that don’t eat junk food and a couple of them have
passed out due to low sodium or also get light-headed.
So, as with everything, there needs to be balance.
I don’t use Mortons, just plain old rock salt.
Understood, that too much salt causes major problems.

Hi, Sandy. Yes, it is possible to consume too little salt. That is generally not a problem for most people, because our food supply is heavily salted. Most people consume far too much salt. The real issue is the balance between salt, water, and potassium. If you are experiencing light-headedness without salt, then you may need a little bit. As you say, too much salt causes problems, so make sure your intake is not excessive. I hope that helps!

Dr. Greger’s comments on salt are based on misleadingly selective citations of the literature. I appreciate Dr. Greger’s evidence-based analyses, but this time they are just not valid.

An article recently published in the Lancet, for which I give the reference below, states unequivocally “after studying more than 130000 people from 49 different countries, (a study) concluded that salt restriction reduced the risk of heart disease, stroke, or death ONLY IN PATIENTS WHO HAD HIGH BLOOD PRESSURE and that SALT RESTRICTION COULD BE HARMFUL if salt intake became too low.” Another study following 94378 adults aged 35–70 years from 18 countries “documented an iINVERSE CORRLATION between sodium intake and myocardial infarction and mortality.” There are lots more details that I won’t subject you to here, but it’s easy to look them up in the article. The authors are not salt-industry hacks, but established academic cardiology researchers in Switzerland, Poland and the US.

For most of us salt is not harmful, but is in fact healthy!
—————
Messerli, Franz H., Louis Hofstetter, and Sripal Bangalore. “Salt and heart disease: a second round of “bad science”?.” The Lancet 392.10146 (2018): 456-458.

Hi Garret Moddel, thanks for your comment. When Dr Greger reviews research to indicate sodium reduction it is because it is part of the dietary recommendation for Americans to limit salt intake to 2300 mg which s about a 1 teaspoon. Unfortunately when people rely on fast food and processed food the salt intake is much higher than the recommended amount for health. An individual who has hypertention will do better when their salt intake is restricted and their potassium intake is higher as it is indicated in study that you refer to. Those individuals who have normal blood pressure is because their body has the ability to adjust the salt and potassium ratio Over the long term, your kidneys are primarily responsible for blood pressure. In fact, many blood pressure lowering medications work by triggering the kidneys to release excess sodium and fluid.

Thank you for your response. The point is that the dietary recommendations that you quote were shown to be incorrect for for the levels of salt intake in America (as opposed to China, where the sodium intake is excessive). There was an increase in blood pressure with salt intake, but as I wrote above, this was correlated with a DECREASE in heart disease, no matter what function the kidneys are playing. It is stated that the salt possibly “exerts a cardioprotective effect.”

In other podcasts Dr. Greger has made insightful comments that we should not take a change in a correlate for an illness as necessarily predicting a change in the likelihood of the illness. An example that comes to mind is reduction of LDL with diet or supplementation, which does not produce the same healthful effect as having a low LDL in the first place. Here, we need to be careful not to take an increase in blood pressure as a predictor of heart disease. The opposite has shown to be the case for salt.

Does this mean that we should go out and eat as much salt as possible? No, but we don’t need restrict it either. In any case, as you state, increasing potassium intake is good.

1) the opinion article you quote is not a research study. Its an opinion, and if you look at the fine print, you’ll see that the authors get funding from several pharmaceutical companies that profit from blood pressure lowering medication.

2) there may be some truth to the “cardioprotective effect of salt”, but that’s just one organ system and just one avenue for premature death and disease. In addition, the research data is mixed and conflicting with no clear path to a compelling conclusion. A better hard endpoint is obviously ACM (all cause mortality). There are many studies that demonstrate an increase in ACM with sodium intake, even at the lowest sodium consumption levels. Here is one example:

J Am Coll Cardiol. 2016 Oct 11; 68(15): 1609–1617.

The most logical avenue is to eat an unprocessed whole food plant based diet and don’t add anything refined, like salt. Fresh veggies have plenty of sodium to meet your daily requirement which is generally agreed to be about 200-500 mg/day, and of course, massive amounts of naturally occuring potassium which is just as important as no added sodium.